Effects of ginger (Zingiber officinale) on gingival fibroblasts: An in vitro study.

OBJECTIVES: Ginger, the powdered rhizome of the herb Zingiber officinale, is commonly used as a traditional medicine in many areas around the world. Anti-inflammatory actions of its extract have been previously reported. The aim of this study was to investigate the effect of ginger extract on matrix metalloproteinase (MMP) and interleukin (IL) expression from human gingival fibroblasts (HGFs) in vitro. MATERIAL AND METHODS: HGFs were obtained from subcultures of biopsies from clinically healthy gingival tissues of 10 patients. Ginger extract was prepared from commercial powder of rhizome of Z. officinale (GZO) and its effect on cell viability was assessed using the 3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyl tetrazolium bromide cytotoxicity assay. Cells were then incubated and treated (except for the control samples) with either GZO, lipopolysaccharides (LPS), and GZO before or after LPS stimulation. Culture supernatants of all five samples were collected for the Milliplex analysis to measure MMP-1, MMP-2, MMP-8, MMP-9, IL-1ß, and IL-8. One-way analysis of variance and Duncan multiple range tests were used to compare the mean values of all groups. RESULTS: The gingerextract showed minimal cytotoxicity to HGFs even with the maximum tested concentration. Compared to the control group, GZO treatment alone caused little or no effect on the levels of expression of MMP-1, MMP-2, MMP-8, MMP-9, IL-1ß, and IL-8. While GZO treatment after LPS stimulation significantly reduced the expression of MMP-1, MMP-2, MMP-8, MMP-9, and IL-8 when compared to LPS alone. Comparing the control to LPS stimulation after GZO treatment, significant differences were detected for all tested MMPs and cytokines. CONCLUSIONS: These findings suggest a potential role for ginger extract in inhibiting MMP and IL HGFs' expression in inflamed gingival tissues.

Antimicrobial capacity of photodynamic therapy on oral health-related quality of life and halitosis among elderly patients wearing removal dentures.

PURPOSE: The aim of the present clinical trial was to evaluate the efficacy of antimicrobial photodynamic therapy (PDT) for the treatment of halitosis in elderly patients wearing dentures. METHODS: Elderly patients (>60 years age) wearing complete dentures and diagnosed with halitosis (H2S levels >112 ppb) were divided into two groups: patients undergoing treatment with tongue scraper and full mouth disinfection (Group I) and patients undergoing treatment with tongue scraper, full mouth disinfection and single application of PDT (Group II). Oral health related quality of life (OHRQoL) was assessed using a 14-point Likert scale used in oral health impact profile (OHIP). The assessment of halitosis was done with the help of a device called Oral Chroma™. Microbial sampling for detection of Porphyromonas gingivalis (P. gingivalis) was performed from the dorsum of the tongue using a sterile swab at baseline and after treatment on day 5, 15 and 30 and quantified using polymerase chain reaction. RESULTS: Forty elderly patients with halitosis completed the trial. The mean age in Group I and Group II was estimated to be 66.42 years and 67.91 years, respectively. Group II participants also maintained good OHRQoL in the post-operative period that reported statistically significant difference when compared with the control group (p < 0.01). Group II showed significant improvement in H2S concentration values at final analysis compared to Group-I (p = 0.001). P. gingivalis showed statistically significant reduction on day 5 only with PDT in Group II (p < 0.05). CONCLUSION: Antimicrobial PDT helped in reducing H2S gas concentration and improving quality of life in elderly patients wearing dentures. A significant reduction of P. gingivalis occurred only in the short-term follow-up.

Evaluation of quality of life among dental students using WHOQOL-BREF questionnaire in Saudi Arabia: A cross sectional study.

OBJECTIVE: The objective was to use modified version of WHOQOL-BREF to assess the well-being and QOL of dental students of King Saud University based on four major domains. METHODS: The questionnaire related to the survey was distributed to all dental students (N= 782) who were enrolled from 1st year to 5th year in College of Dentistry, King Saud University in the fall of 2018. The questionnaire comprised of four domains having different set of questions i.e. Physical domain, Psychological domain, Environmental domain and Social relationship domain. Two stand-alone questions related to (Overall Quality of life and Satisfaction with health) were also part of the WHOQOL-BREF questionnaire. Cronbach's Alpha was used to assess the reliability of the WHOQOL-BREF domains. Paired t-tests were conducted to compare the means of the four domains and chi-square. Chi-square test was used to find association of demographic characteristics with four domains and two stand-alone questions. RESULTS: The overall quality of life and satisfaction with health of the dental students was found to be satisfactorily favorable with environmental domain and moderately favorable with social relationship and physical health domains. Physical health domain with psychological domain was statistically significant (p-value <0.001) whereas physical health domain with social relationship and environmental domain was also found to be statistically significant (p-value <0.001). Respondents, who highly rated their overall quality of life and satisfaction with health, had higher domain scores. CONCLUSION: In the present study, overall quality of life and satisfaction with health of dental students in King Saud University was found to be satisfactorily favorable.

Comparison of clinical peri-implant indices and crestal bone levels around narrow and regular diameter implants placed in diabetic and non-diabetic patients: A 3-year follow-up study.

BACKGROUND: Studies evaluating and comparing clinical and radiographic peri-implant indices around narrow diameter implants (NDIs; <3.3 mm) and regular diameter implants (RDIs) in type-2 diabetes mellitus (T2DM) and non-diabetic individuals are deficient. OBJECTIVE: To estimate and compare the clinical and radiographic indices around NDIs and RDIs placed in T2DM and non-diabetic patients. MATERIALS AND METHODS: Eighty-six patients requiring implant surgery in the posterior mandible were divided into two groups (42 T2DM and 44 non-diabetic individuals). Patients were further categorized into two subgroups on the basis of diameter of implants: (1) patients with NDIs (3.3 mm ø) and (2) patients with RDIs (4.1 mm ø). Clinical indices evaluating plaque index (PI), bleeding on probing (BOP), probing depth (PD), and crestal bone levels (CBL) were recorded around all dental implants at 18 and 36 months follow up. Serum hemoglobin A1c (HbA1c) test was carried out for both groups to assess the profile of glycosylated hemoglobin at baseline, 18 and 36 months of follow up. RESULTS: The mean age of patients in T2DM group and non-diabetic group was 45.2 and 41.6 years, respectively. At 18 and 36 months follow up, mean HbA1c levels were 6.5% and 4.5% and 6.7% and 4.5% in T2DM and non-diabetic individuals, respectively. A statistically significant reduction in mean HbA1c levels from the baseline to respective follow-up periods were seen in T2DM patients. There was no statistically significant difference in the overall mean scores of PI, BOP, PD, and CBL around NDIs and RDIs among T2DM and non-diabetic patients at 18 and 36 months of follow up. CONCLUSION: NDIs show reliable clinical stability and radiographic bone levels as RDIs placed in T2DM and non-diabetic individuals, provided oral hygiene and glycemic status are strictly maintained.

Clinical and radiographic peri-implant variables around short dental implants in type 2 diabetic, prediabetic, and non-diabetic patients.

BACKGROUND: Clinical and radiographic status around short dental implants in patients with different glycemic levels remains unexplored. PURPOSE: To determine the clinical and radiographic bone level (RBL) around short dental implants in type-2 diabetes mellitus (T2DM), prediabetic, and non-diabetic patients. MATERIALS AND METHODS: Participants were grouped into three groups based on HbA1c levels: T2DM (Group-1); prediabetic patients (Group-2); and non-diabetic subjects (Group-3). Clinical recordings included the assessment of peri-implant plaque index (PI), bleeding on probing (BOP), probing depth (PD). Radiographic analysis included evaluation of standardized periapical digital radiographs using specialized software and image analyzer. RESULTS: Clinical peri-implant parameters including PI and BOP were statistically significantly higher in group-1 (P < .01) and group 2 (P < .05) as compared to group-3. Mean PD was statistically significantly higher in group-1 patients compared to group-3 (P < .01). Radiographic bone loss was significantly higher in both group-1 (P < .01) and group-2 (P < .05) patients as compared to patients in group 3. RBL showed statistically significant difference among T2DM patients even after adjusting for HbA1c, total cholesterol, and body mass index (P < .05) and statistically significant difference in prediabetic patients after adjusting for only HbA1c (P < .05). CONCLUSION: Clinical and radiographic peri-implant parameters are compromised around short dental implants in type-2 diabetes mellitus patients. Further longitudinal studies are needed to compare clinical performance of short dental implants with standard dental implants placed in patients with different glycemic level.

Clinical indices and local levels of inflammatory biomarkers in per-implant health of obese and nonobese individuals.

BACKGROUND: Obesity seem to regulate peri-implant health. It is proposed that peri-implant crevicular fluid (PICF) levels of interleukin (IL)-1ß and IL-6 are higher in obese as compared to nonobese individuals. OBJECTIVE: The purpose of the present clinico-laboratory study is to estimate and compare the clinical and radiographic indices and PICF levels of IL-1ß and IL-6 among obese and nonobese patients. MATERIALS AND METHODS: Fifty patients were divided into two groups (25 obese with ≥27.5 kg/m2 and 25 nonobese with <27.5 kg/m2 individuals). Clinical indices for both periodontal and peri-implant evaluating plaque index (PI), bleeding on probing (BOP), probing depth (PD), clinical attachment level (CAL), and crestal bone loss (CBL) were recorded around teeth and implants. PICF was collected and assessed for the levels of IL-1ß and IL-6 using enzyme-linked immunosorbent assay. RESULTS: A significant difference was observed in PI and BOP around natural teeth and implants in obese patients, respectively (P < .05). CBL was found to be significantly higher among obese as compared to nonobese patients (P = .022). Peri-implant and periodontal PD was higher in obese as compared to nonobese but did not reach statistical significance. Levels of IL-1ß and IL-6 were statistically significantly higher among obese patients as compared to nonobese (P = .001). Pearson correlation analysis showed IL-1ß was positively correlated with CBL (P = .0079), whereas IL-6 showed positive correlation with both BOP (P = .0019) and CBL (P = .015) among obese patients. CONCLUSIONS: Clinical peri-implant parameters were worse and proinflammatory biomarkers were significantly higher in obese patients compared with nonobese subjects. The findings of the present study suggests that increased proinflammatory biomarkers in PICF of obese patients may modulate peri-implant inflammation around dental implants.

Low-intensity laser for harvesting palatal graft for the treatment of gingival recession: A systematic review.

The aim of the present study was to assess the efficacy of low-intensity laser therapy (LILT) for harvesting palatal connective tissue graft (PCTG) in the treatment of gingival recession. Databases were searched up to May 2018. The addressed focused question was: Is adjunctive LILT effective in the healing of donor palatine area after harvesting PCTG? Screening of the initially identified studies resulted in four clinical studies. All studies showed that LILT was effective in improving clinical outcomes, such as tissue thickness, postoperative discomfort, remaining wound area, and visual analog score at follow up. Upon comparison with the control group, two studies showed significantly greater improvements in the clinical parameters and patient-centered outcomes for LILT than control groups at follow up. Due to the low number of included clinical studies, it remains debatable whether LILT improves clinical and patient-centered outcomes of PCTG procedures. Further randomized controlled trials are needed to evaluate the outcomes of LILT on the healing of donor palatine area after harvesting PCTG.

Current trends in antibiotic prescription behavior among Saudi dentists performing implant surgery: A cross-sectional observational study.

AIM: The aim of the present study was to investigate current trends in antibiotic prescription behavior among dentists performing implant surgery. METHODS: A cross-sectional observational study was conducted among 133 dental specialists in Saudi Arabia. A self-administered questionnaire comprising of 21 questions related to basic demographic details (ie, sex, age, nationality, undergraduate training, type of specialty, clinical, and implant practice experience) made up the first part of the questionnaire. The second part of the questionnaire consisted of 12 close-ended questions concerning knowledge and opinions of the dental specialists related to antibiotic prescription patterns pre- or post-implant surgeries. Data were compiled and analyzed using SPSS version 20. Descriptive statistics were employed to calculate the means and percentages for demographic data and preoperative and postoperative antibiotic-prescribing habits in dental implant placement. RESULTS: All practicing dentists prescribed antibiotics preoperatively prior to routine dental implant placement; 41.4% (N = 55) of participants were in favor of recommending antibiotics after routine dental implant placement (postoperatively). CONCLUSION: Antibiotic-prescribing patterns in implant surgery among Saudi dentists are diverse and inconsistent. Further studies are required to investigate the effect of prophylactic antibiotics in lowering the risk of implant failure.

Knowledge, attitude and practice of antibiotic use and misuse among adults in Riyadh, Saudi Arabia.

OBJECTIVES: To assess the knowledge, attitude, and practice of antibiotics (ABs) use and misuse among adults living in Riyadh, Saudi Arabia. Methods: In this cross-sectional study, a self-administered questionnaire was distributed to participants from  March 2016 to January 2017 in the outpatient department of King Khalid University Hospital and Dental Hospital, King Saud University, Riyadh, Saudi Arabia. The questionnaire was divided into 4 sections. The first and second section inquired regarding demographic details and knowledge of ABs. The third section assessed practice of ABs and the fourth section assessed attitude of participants towards ABs use. Questionnaires were hand delivered to respondents using convenience sampling. Statistical analysis using frequency distributions and knowledge responses of AB resistance for 'yes' and 'no' were associated with participant characteristics using Chi-square test.  Results: A total of 1966 questionnaires were completed (response rate: 93.5%). Sixty-seven percent of the respondents were unaware of the meaning of ABs resistance. Sixty-seven percent of respondents were unaware of ABs being harmful for children's teeth and 64.9% unaware of ABs that develop allergy and death.  Twenty-four percent believed that ABs worked on viruses, 31% on cold and 21% can cure cough. Almost 51% used ABs without physician prescription while 37.5% obtained ABs directly from pharmacists without physician's prescription. Almost 42% participants discontinued ABs on alleviation of symptoms. There was significant difference in knowledge response of AB resistance and source of AB use (p=0.026), reason of AB use (p=0.038) and discontinuation of ABs (p=0.041). Conclusion: Adults showed insufficient knowledge and understanding regarding the safe use of ABs consumption among the population.

The Effects of Plantago major on the Activation of the Neutrophil Respiratory Burst.

Plantago major is a common plant that grows worldwide in temperate zones and is found in fields, lawns, and on the roadsides. Its leaves and seeds have been used in almost all parts of the world for centuries as a wound healer, analgesic, antioxidant, and antibiotic, as well as an immune system modulator, antiviral, antifungal, and anti-inflammatory agent. Baicalein and aucubin are the two most biologically active components of P. major, and both have been shown to have antioxidant, anti-inflammatory, and anticancer properties. Neutrophils have a pivotal role in wound healing and inflammation. Their principal mechanism of host defense is the killing of pathogens via the production of reactive oxygen species (ROS). The aim of the present study was to determine the in vitro effects of P. major extract, baicalein, and aucubin on human neutrophil respiratory burst activity. The cytotoxicity of the agents was assessed by lactate dehydrogenase (LDH) assays. A standard luminol-dependent chemiluminescence (CL) assay was utilized to monitor the respiratory burst of the neutrophils after exposure to P. major extract and its two active ingredients, baicalein and aucubin. Three replicates per group were included in each of the three runs of the experiments and analysis of variance (ANOVA) was used for statistical analysis. P. major and baicalein were not toxic to the cells at any of the concentrations examined. Aucubin was toxic to the cells only at the highest concentration tested (P = 0.0081). However, genistein was toxic to the cells at all of the concentrations examined except for the lowest concentration of 16.9 µg/ml (P = 0.985). P. major (-0.10 ± 0.11), aucubin (0.06 ± 0.16), baicalein (-0.10 ± 0.11), and genistein (-0.18 ± 0.07) all significantly (P < 0.0001) inhibited ROS production from the neutrophils. P. major extract inhibited neutrophil ROS production, as did aucubin and baicalein. Therefore, these components should be investigated further with relation to the regulation of destructive ROS production in conditions such as periodontal disease.

Effects of Calendula officinalis on human gingival fibroblasts.

BACKGROUND: Calendula officinalis is commonly called the marigold. It is a staple topical remedy in homeopathic medicine. It is rich in quercetin, carotenoids, lutein, lycopene, rutin, ubiquinone, xanthophylls, and other anti-oxidants. It has anti-inflammatory properties. Quercetin, one of the active components in Calendula, has been shown to inhibit recombinant human matrix metalloproteinase (MMP) activity and decrease the expression of tumor necrosis factor-α, interleukin-1ß (IL), IL-6 and IL-8 in phorbol 12-myristate 13-acetate and calcium ionophore-stimulated human mast cells. OBJECTIVES: To examine the effects of Calendula on human gingival fibroblast (HGF) mediated collagen degradation and MMP activity. MATERIAL AND METHODS: Lactate dehydrogenate assays were performed to determine the non-toxic concentrations of Calendula, doxycycline and quercetin. Cell-mediated collagen degradation assays were performed to examine the inhibitory effect on cell-mediated collagen degradation. Gelatin zymography was performed to examine their effects on MMP-2 activity. The experiments were repeated three times and ANOVA used for statistical analyses. RESULTS: Calendula at 2-3% completely inhibited the MMP-2 activity in the zymograms. Doxycycline inhibited HGF-mediated collagen degradation at 0.005, 0.01, 0.02 and 0.05%, and MMP-2 activity completely at 0.05%. Quercetin inhibited HGF-mediated collagen degradation at 0.005, 0.01 and 0.02%, and MMP-2 activity in a dose-dependent manner. Calendula inhibited HGF-mediated collagen degradation and MMP-2 activity more than the same correlated concentration of pure quercetin. CONCLUSION: Calendula inhibits HGF-mediated collagen degradation and MMP-2 activity more than the corresponding concentration of quercetin. This may be attributed to additional components in Calendula other than quercetin.

Effects of cigarette smoke condensate on oral squamous cell carcinoma cells.

OBJECTIVE: Epidemiological studies have reported that tobacco use is a major etiological factor for oral cancer. Several matrix metalloproteinases (MMPs) have been shown to play important roles in the invasion and metastasis of oral squamous cell carcinomas, especially MMP-2 and MMP-9. This study examined the effects of cigarette smoke condensate (CSC) on oral cancer cells. DESIGN: Two oral squamous cell carcinoma cell lines, SCC-25 (metastatic) and CAL-27 (non-metastatic), were exposed to different concentrations of CSC and examined for their collagen degrading ability and MMP production using collagen degradation assays, zymograms and Western blots. RESULTS: Exposure to CSC increased the collagen degrading ability of the metastasizing cell line (SCC-25) by a mechanism involving increased MMP-2 and MMP-9 production. CONCLUSION: CSC increased the collagen degrading ability of SCC-25 by increasing the MMP-2 and MMP-9 protein levels. Continued cigarette smoking in oral cancer patients may result in decreased survival rates due to enhanced metastatic potential of the cancer cells.

Responses of human neutrophils to nicotine and/or Porphyromonas gingivalis.

BACKGROUND: Tobacco smoking is considered a major modifiable risk factor for periodontal disease. Nicotine is the addictive ingredient in tobacco and has been shown to affect multiple cellular processes. Neutrophils are the first line of host defense and are critical cells in the maintenance of periodontal health through their role in the control of bacteria, but they can also contribute to the progression of periodontal disease by the production and release of reactive oxygen species (ROS). Virulence factors from periodontal pathogens, such as Porphyromonas gingivalis (Pg), stimulate the respiratory burst of neutrophils. The objective of this study is to explore the oxidative activity of neutrophils when stimulated with Pg, nicotine, or both. METHODS: Neutrophils were separated from buffy coats by the double dextran gradient method. The generation of ROS by neutrophils was determined using luminol-dependent chemiluminescence assays. The reaction was followed for 90 minutes, and the neutrophil activation was recorded as the total integrated energy output. RESULTS: The Pg and Pg plus nicotine groups had a significantly higher active and peak chemiluminescence than the nicotine group (all with P <0.0001). The Pg and Pg with nicotine groups were not significantly different (P = 0.90). CONCLUSION: In the presence of Pg, the nicotine did not further enhance the ROS release by the neutrophils, suggesting that the bacteria induced the maximum ROS release in this model system.

Effects of provisional acrylic resins on gingival fibroblast cytokine/growth factor expression.

STATEMENT OF PROBLEM: Several studies have reported that polymerized resin materials may release agents into surrounding tissues. These agents could alter cytokine/growth factor expression. PURPOSE: The purpose of this study was to determine the effects that provisional acrylic resins have on cell toxicity and the expression of cytokines/growth factors from human gingival fibroblasts (HGFs). MATERIAL AND METHODS: The materials used in this study were chemically activated bis-acryl composite (Chem-Bis), chemically activated polyethyl methacrylate (Chem-PEMA), chemically activated polymethyl methacrylate (Chem-PMMA), and heat-activated polymethyl methacrylate (Heat-PMMA) resins. HGFs were incubated for 72 hours in the presence of eluate from each resin and in the absence of any eluate (negative control). The conditioned media were then collected and stored at -70 degrees C. Cell toxicity was determined using a lactate dehydrogenase method. Cytokine/growth factor expression was examined using cytokine antibody arrays. The experiments were repeated 3 times. The data were analyzed with 1-way ANOVA, Mann-Whitney test, and 1-sample t test (alpha=.05). RESULTS: There was no significant cell toxicity observed from the eluates. The cytokine/growth factor expression induced by Chem-Bis was significantly greater than the control for growth-regulated oncogene (GRO) (P<.001), monocyte chemoattractant protein-1 (MCP-1) (P=.031), and tumor necrosis factor-beta (TNF)-beta (P=.009). For Chem-PEMA, the cytokine/growth factor expression was significantly greater than the control for GRO-alpha (P=.022), interleukin (IL)-13 (P=.031), and TNF-alpha (P=.017). The cytokines/growth factors induced by Chem-PEMA were significantly less than the control (P=.008) and Chem-Bis for IL-8 (P=.042). The expression induced by Chem-PMMA was significantly greater than the control for IL-13 (P=.036), IL-1 alpha (P=.003), IL-2 (P=.020), and IL-5 (P=.045). Finally, Heat-PMMA induced significantly greater levels than the control for GRO (P<.001) and IL-13 (P=.008). CONCLUSIONS: This study demonstrated that the resins evaluated were nontoxic to the HGFs. There were changes in the cytokine/growth factor levels that were statistically significant, but may not be clinically significant.

Effects of Porphyromonas gingivalis on human gingival fibroblasts from healthy and inflamed tissues.

BACKGROUND AND OBJECTIVE: This study compared the ability of human gingival fibroblasts (HGFs) isolated from healthy and inflamed gingival tissues to degrade collagen in the presence and absence of Porphyromonas gingivalis supernatant. MATERIAL AND METHODS: Human gingival fibroblasts were cultured from explants of 21 healthy and 21 inflamed periodontal tissues. The HGFs that grew out of the explants were seeded in the center of six-well plates coated with collagen in the presence and absence of 10% P. gingivalis supernatant. An inflamed and a healthy cell line were also evaluated with Arg-gingipain. After 6 days, Coomassie Blue was used to visualize the collagen cleavage. RESULTS: The collagen was totally cleaved in 12 (aggressive) of the 21 cell lines isolated from the inflamed tissues in the presence of P. gingivalis. The remaining nine cell lines (non-aggressive) cleaved only the collagen underneath the cell colonies in the presence of P. gingivalis. Of the healthy tissues, five (aggressive) of the 21 cell lines cleaved all the collagen and 16 cell lines (non-aggressive) only cleaved the collagen underneath the cell colonies in the presence of P. gingivalis. All the collagen was cleaved by an aggressive cell line and only the collagen underneath the cell colonies was cleaved by a non-aggressive cell line in the presence of Arg-gingipain. CONCLUSION: The collagen in the wells was more readily cleaved by the inflamed than by the healthy cell lines, and the difference was statistically significant (p = 0.0278). Arg-gingipain gave identical results to the P. gingivalis supernatant.